Emergency Department Wait Time Case Study

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Overview

Patients entering the emergency room at this hospital were experiencing delays, so emergency department leadership used lean process improvement tools to streamline processes and improve the patient experience. This hospital, which was once the lowest performer in the health system, became the “best in the system” after this rapid process improvement event.

The Study

ER patients at a South Florida hospital were experiencing substantial delays in being admitted into the hospital. Length of stay (LOS) times averaged 289 minutes, which led to unnecessary anxiety for patients and delayed access to the best possible care.

Preparation

The problem was defined and the scope of the Kaizen was specified. A team was selected with participants from a variety of roles in the Emergency Department. The chief of emergency medicine led the team and received a complete set of lean resources to review before the Kaizen began.

Event

During the Kaizen, a value stream map was used to track and better visualize the process and identify value-adding moments. An average LOS of 289 minutes was confirmed. Using lean principals as their guide, the Kaizen team focused on reduction of waste, lead times, cycle times and hand-offs. Examination of the future state value stream map found that 60 minutes could be reduced from the process through standardization of certain elements. During the entire event, the Kaizen team began each morning by detailing the tools and principles to be used, as well as facilitating the decision-making processes through guidance. Each day concluded with a leaders' meeting report to administration.

Results

Patient flow at this facility was tracked along a series of stations for every case. One month after the Kaizen, the average patient wait time for the following stages was reduced:

"In Bed" to "Physician Greet" from 12 minutes to six, a 50% reduction

"Physician Greet" to "Disposition, Admissions" from 242 minutes to 224, a 7% reduction

"Physician Greet" to "Disposition, Departs" from 137 minutes to 120, a 12% reduction

Overall Average Length of Stay from 289 minutes to 243, a 16% reduction

The facility, which had been tagged as "worst in the system" of over 20 hospitals, received regular postings as "best in the system" after the Kaizen.